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K Rost

Publications and source records attributed to K Rost.

54 records · Page 3Linked to original sources
PubMed1986

Smoking cessation: a practical guide for the physician.

Physicians play critical roles in efforts to encourage nonsmoking, both in their individual interventions with smokers and in their contributions to broader political, educational, and public health efforts to encourage nonsmoking. These broader efforts, much aided by the authority and concern of individual physicians and organized medicine will continue, also, to provide a supportive background for individual clinical efforts. Together, the broad based and the clinical activity potentiate each other in decreasing the prevalence of smoking. The difficulties individuals experience in quitting smoking are best understood when placed within the context of the billion dollar marketing of an addictive product; the reality that quitting smoking occurs gradually over time, many smokers attempting to quit several times before succeeding; and the influence of physicians' continuing clinical and community activity in maintaining a culture actively cognizant of the risks of smoking. Through brief clinical counseling as outlined in this article, physicians can help almost all of their smoking patients move toward becoming a nonsmoker by trying to quit or, at least, giving greater thought to doing so. Additionally, the physician can help patients eager to quit by referral to well developed programs and materials such as have been described. In all, then, numerous effective resources are available for the clinician who wishes to deal responsibly with the most important preventable cause of morbidity and mortality in the approximately 30 per cent of patients who smoke.

Counseling↗
PubMed1984

Factors associated with the use of child restraint devices.

A thorough behavioral diagnosis of why parents do and do not use car safety seats is important for designing an effective, comprehensive approach to the significant public health problem of childhood motor vehicle occupant deaths and injuries. With a clear understanding of the demographic, knowledge, attitudinal and social support factors related to car seat use, it will be possible to develop or refine program methods and persuasive communication strategies which will have the greatest potential for effectiveness. Project KISS (Kids in Safety Seats) of the Maryland Department of Health and Mental Hygiene surveyed parents of young children in Maryland to identify factors which differentiate child restraint device users from nonusers. A statewide telephone survey was conducted using random digit dialing, a method of computerized sampling for telephone interviewing. The survey instrument incorporated demographic variables and used Fishbein and Ajzen's model of behavioral intention to develop an attitude scale and identify social referents important to parental safety seat use. Of the factors associated with reported use of car seats, the attitudinal variables were extremely significant. Using these variables as well as spouse approval, socio-demographic characteristics, and other preventive health behaviors of parents, resulted in the correct classification of 75.5% of cases and 26.7% of the variance in reported car seat use. Practitioners can use this analysis to design and target effective educational efforts to those individuals who are least likely to use car seats properly and consistently.

Adult↗
PubMedDate not supplied

Primary care physicians' approach to depressive disorders. Effects of physician specialty and practice structure.

BACKGROUND: Because primary care physicians (PCPs) are the initial health care contact for most patients with depression, they are in a unique position to provide early detection and integrated care for persons with depression and coexisting medical illness. Despite this opportunity, care for depression is often suboptimal. OBJECTIVE: To better understand how to design interventions to improve care, we examine PCPs' approach to recognition and management and the effects of physician specialty and degree of capitation on barriers to care for 3 common depressive disorders. METHODS: A 53-item questionnaire was mailed to 3375 randomly selected subjects, divided equally among family physicians, general internists, and obstetrician-gynecologists. The questionnaire assessed reported diagnosis and treatment practices for each subject's most recent patient recognized to have major or minor depression or dysthymia and barriers to the recognition and treatment of depression. Eligible physicians were PCPs who worked at least half-time seeing outpatients for longitudinal care. RESULTS: Of 2316 physicians with known eligibility, 1350 (58.3%) returned the questionnaire. Respondents were family physicians (n = 621), general internists (n = 474), and obstetrician-gynecologists (n = 255). The PCPs report recognition and evaluation practices related to their most recent case as follows: recognition by routine questioning or screening for depression (9%), diagnosis based on formal criteria (33.7%), direct questioning about suicide (58%), and assessment for substance abuse (68.1%) or medical causes of depression (84.1%). Reported treatment practices were watchful waiting only (6.1%), PCP counseling for more than 5 minutes (39.7%), antidepressant medication prescription (72.5%), and mental health referral (38.4%). Diagnostic evaluation and treatment approaches varied significantly by specialty but not by the type of depression or degree of capitation. Physician barriers differed by specialty more than by degree of capitation. In contrast, organizational barriers, such as time for an adequate history and the affordability of mental health professionals, differed by degree of capitation more than by physician specialty. Patient barriers were common but did not vary by physician specialty or degree of capitation. CONCLUSIONS: A substantial proportion of PCPs report diagnostic and treatment approaches that are consistent with high-quality care. Differences in approach were associated more with specialty than with type of depressive disorder or degree of capitation. Quality improvement efforts need to (1) be tailored for different physician specialties, (2) emphasize the importance of differentiating major depression from other depressive disorders and tailoring the treatment approach accordingly, and (3) address organizational barriers to best practice and knowledge gaps about depression treatment.

Capitation Fee↗
PubMedDate not supplied

Competing demands from physical problems: effect on initiating and completing depression care over 6 months.

OBJECTIVE AND DESIGN: To evaluate a cohort of patients with major depression to examine the effect of competing demands on depression care during multiple visits over 6 months. PARTICIPANTS AND SETTING: Ninety-two patients with 5 or more symptoms of depression and no recent depression treatment were evaluated by 12 primary care physicians in 6 practices in the usual-care arm of an effectiveness trial of the Agency for Health Care Policy and Research Depression Guidelines. MAIN OUTCOME MEASURE: Treatment was considered to be initiated if the patient reported starting a guideline-concordant antidepressant medication or making a visit for specialty counseling. Treatment completion was defined as either a 3-month course of guideline-concordant antidepressant use or completion of 8 or more specialty counseling visits. RESULTS: Among the 92 patients reporting no recent treatment at study enrollment, 57% reported starting and 17% reported completing a course of guideline-concordant antidepressant medication and or specialty counseling at the 6-month interview. The severity of physical problems among patients with high enthusiasm for depression treatment decreased the odds that patients would initiate depression therapy. Severity of physical problems had no observable effect on completing depression therapy in the group of patients who initiated treatment. CONCLUSIONS: Physical problems compete with depression for attention over multiple visits in untreated patients who are enthusiastic about getting care for their emotional problems. Interventions are needed for this high-risk group, because depression treatment could potentially enhance patients' treatment of their physical problems. Arch Fam Med. 2000;9:1059-1064

Adult↗
PubMedDate not supplied

The teacher simulation exercise: changes in physician teaching emphasis and strategy. The SGIM Task Force on the Medical Interview.

OBJECTIVES: The objective of the study was to determine the effect of a faculty development course in teaching medical interviewing on participants' ability to provide effective feedback to interviewers. DESIGN: The study used a non-concurrent control group design which randomized subjects into two groups before the intervention. The two groups completed different pre-tests; each group then completed the other group's pre-test as its post-test. The post-course scores of one group were compared with the pre-course scores of the other group to establish differences. SETTING: The research was conducted at the 1985 faculty development course sponsored by the SGIM Task Force on the Medical Interview. PARTICIPANTS: 49 of 52 teachers of medical interviewing attending the course completed the study. INTERVENTION: The week-long intervention consisted of a variety of educational activities which assisted the participants in defining and actively pursuing their learning objectives in interviewing, teaching, and self-awareness. MEASUREMENTS AND MAIN RESULTS: In their assessment of two videotaped segments of initial medical visits, participants were more likely after the course to comment on the interviewer's lack of attention to patient affect (69.0% versus 27.2%, p = 0.005 in one segment) and somewhat more likely to identify teaching strategies that actively involved the interviewer (47.2% vs. 35.0%, p = 0.09 in one segment). Both shifts were congruent with assessments made by course faculty. CONCLUSIONS: Faculty development can influence teachers to recognize the need to provide feedback on skills that expert teachers would emphasize. The non-concurrent control group design provides an innovative approach to common constraints in evaluating faculty development courses.

Curriculum↗
PubMedDate not supplied

Antisocial personality disorder in primary care patients with somatization disorder.

Antisocial personality disorder and somatization disorder (SD) have been associated in previous research conducted primarily in patients from the mental health setting. We tested the hypothesis that patients with SD from the primary care setting had less likelihood of having comorbid antisocial personality disorder in a sample of 118 patients with SD. Two methods for diagnosing antisocial personality disorder were used: the Diagnostic Interview Schedule (DIS) and the Structured Clinical Interview for DSM-III-R, axis II (SCID-II). Eight percent of the women and between 18% and 25% (depending on the method used) of the men had antisocial personality, a prevalence rate that clearly exceeds the rate found in the general population. However, in clinical work, only one in 10 women and one in six men with SD will have antisocial personality disorder. These findings are consistent with the shared biological substrate hypothesized for the two disorders.

Adult↗
PubMedDate not supplied

Enhancing the health of somatization disorder patients. Effectiveness of short-term group therapy.

To identify an effective method of treating patients with somatization disorder (SD), the authors conducted a randomized controlled clinical trial of group therapy with 70 SD patients. Primary care physicians treating all patients in the study received a consultation letter offering treatment recommendations for SD. The experimental patients were invited to attend eight group therapy sessions in addition to the consultation provided to their physicians; 45% attended one or more sessions. The experimental patients reported significantly better physical (P < 0.05) and mental (P < 0.01) health in a 1-year period during and after group therapy. The more group sessions SD patients attended, the greater the improvement in general and mental health. The 52% net savings in health care charges associated with group therapy plus the consultation indicate that it is economically feasible to improve outcomes without escalating the cost of care in this group of high users of medical resources.

Adaptation, Psychological↗
PubMedDate not supplied

Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression.

Complex interventions, which have been shown to improve primary care depression outcomes, are difficult to disseminate to routine practice settings. To address this problem, we developed a brief intervention to train primary care physicians and nurses employed by the practice to improve the detection and management of major depression. Before recruitment began, the research team conducted academic detailing conference calls with primary care physicians and nurses, and provided in-person training with nurses and administrative staff. Administrative staff screened over 11,000 patients before their visits to identify those with probable major depression. Primary care physicians delegated increased responsibility to office nurses, who educated over 90% of patients about effective depression treatment and systematically monitored their progress over time. Early results demonstrate that community primary care practices can rebundle traditional team roles over the short-term to provide more systematic mental health treatment without adding additional personnel. A rigorous evaluation of this effort will reduce time-consuming, expensive, and often unsuccessful efforts to "translate" research intervention findings into everyday practice.

Major Depressive Disorder↗
PubMedDate not supplied

The influence of patient participation on satisfaction and compliance.

This investigation tested how patients' participation in the medical visit is related to their satisfaction and subsequent adherence. Thirty random samples of audiotaped dialogue were used to construct estimates of patient participation during the history, examination, and concluding segment of initial medical visits of 45 older male Veterans Administration patients. The data demonstrate that patients who offer information as well as answer physician questions are significantly more likely to comply with recommendations for new medication. The frequency with which patients interrupt physicians positively correlates with patient satisfaction, and the frequency with which physicians interrupt patients negatively correlates with patient satisfaction. The paper analyzes various examples of patient participation in visits with nationally recognized diabetes educators, and discusses an agenda for further research in the area.

Communication↗
PubMedDate not supplied

Rural and urban problem drinkers in six Southern states.

In 1994-1997 we conducted a four-wave longitudinal study of rural and urban problem drinkers in six Southern United States states to examine rural/urban differences in predictors of service use and course of drinking. This report describes early rural/urban differences from a brief interview with over 3,000 community individuals and among 525 identified problem drinkers. Overall, we found rural/urban differences in alcohol consumption at the community level but only demographic differences among problem drinkers. Our newly developed screening interview for alcohol disorders had excellent agreement (kappa = 0.72) for lifetime disorders and good agreement (kappa = 0.53) for recent disorders against structured diagnostic interviews for DSM-IV criteria.

Adult↗
PubMedDate not supplied

Physician-patient familiarity and patient recall of medication changes. The Collaborative Study Group of the SGIM Task Force on the Doctor and Patient.

Although patients regularly see the same physicain for medical care, little is known about the effects of physician-patient familiarity on important visit outcomes. In a study of visits made to 79 physicians in 11 primary care settings, investigators sought to determine: 1) whether patient recall of prescription medication changes improved as physician-patient familiarity increased, and 2) whether characteristics which predicted recall for newer patients also predicted recall for intermediate and established patients. Sixty-six percent of patients recalled all medication changes recommended during the visit. While recall did not improve as physician-patient familiarity increased, predictors of recall did differ. Generally, the more drug information the physician gave during the concluding segment of the visit, the fewer drug changes the patient remembered. However, this relationship reversed as physician-patient familiarity increased. Elderly patients demonstrated diminished recall regardless of the number of previous visits. The findings suggest that the lengthy provision of drug information actually succeeds in heightening medication recall only when the physician and patient have a well-established relationship. In earlier stages, asking patients to restate recommendations may be a more effective strategy to enhance patient recall.

Age Factors↗